Vulvovaginalkandidose (ausgenommen mukokutane Kandidose): Leitlinie der DGGG, OEGGG und SGGG (S2k-Level, AWMF-Registernummer 015/072, September 2020)

Zusammenfassung

Ziel Das Ziel dieser offiziellen Leitlinie, die von der DGGG, OEGGG und SGGG unter Beteiligung der DMykG, DDG und AGII publiziert und koordiniert wurde, ist es, durch die Evaluation der relevanten Literatur einen konsensbasierten Überblick über die Diagnostik und das Management der Vulvovaginalkandidose zu geben.

Methoden Diese S2k-Leitlinie wurde durch einen strukturierten Konsens von repräsentativen Mitgliedern verschiedener Professionen im Auftrag der Leitlinienkommission der genannten Gesellschaften entwickelt.

Empfehlungen Diese Leitlinie gibt Empfehlungen zu Diagnostik, Management, Beratung, Prophylaxe und Screening der Vulvovaginalkandidose.

Schlüsselwörter

Candida albicans - Leitlinie - Pruritus - vulvovaginale Kandidose

Publikationsverlauf

Eingereicht: 21. Dezember 2020

Angenommen nach Revision: 23. Dezember 2020

Artikel online veröffentlicht:
14. April 2021

• References/Literatur

• 1 Odds FC, Arai T, Disalvo AF. et al. Nomenclature of fungal diseases: a report and recommendations from a Sub-Committee of the International Society for Human and Animal Mycology (ISHAM). J Med Vet Mycol 1992; 30: 1-10
• 2 Loeffler W. Terminology of human mycoses. Nomenclature of mycotic diseases of man. List of accepted German terms translated, arranged and published, together with comments, for the International Society for Human and Animal Mycology (ISHAM). Mykosen 1983; 26: 346-384
• 3 Mendling W. Vaginose, Vaginitis, Zervizitis und Salpingitis. 2. Aufl.. Berlin, Heidelberg: Springer Verlag; 2006
• 4 Sobel JD. Vulvovaginal candidosis. Lancet 2007; 369: 1961-1971
• 5 Romeo O, Criseo G. Candida africana and its closest relatives. Mycoses 2011; 54: 475-486
• 6 Sharma C, Muralidhar S, Xu J. et al. Multilocus sequence typing of Candida africana from patients with vulvovaginal candidiasis in New Delhi, India. Mycoses 2014; 57: 544-552
• 7 Mendling W, Krauss C, Fladung B. A clinical multicenter study comparing efficacy and tolerability of topical combination therapy with clotrimazole (Canesten, two formats) with oral single dose fluconazole (Diflucan) in vulvovaginal mycoses. Mycoses 2004; 47: 136-142
• 8 Mendling W, Niemann D, Tintelnot K. Die vaginale Kolonisation durch Candidaarten unter besonderer Berücksichtigung von Candida dubliniensis. Geburtshilfe Frauenheilkd 2007; 67: 1132-1137
• 9 Hettiarachchi N, Ashbee HR, Wilson JD. Prevalence and management of non-albicans vaginal candidiasis. Sex Transm Infect 2010; 86: 99-100
• 10 Vermitsky JP, Self MJ, Chadwick SG. et al. Survey of vaginal-flora Candida species isolates from women of different age groups by use of species-specific PCR detection. J Clin Microbiol 2008; 46: 1501-1503
• 11 Goswami R, Dadhwal V, Tejaswi S. et al. Species-specific prevalence of vaginal candidiasis among patients with diabetes mellitus and its relation to their glycaemic status. J Infect 2000; 41: 162-166
• 12 Goswami D, Goswami R, Banerjee U. et al. Pattern of Candida species isolated from patients with diabetes mellitus and vulvovaginal candidiasis and their response to single dose oral fluconazole therapy. J Infect 2006; 52: 111-117
• 13 de Leon EM, Jacober SJ, Sobel JD. et al. Prevalence and risk factors for vaginal Candida colonization in women with type 1 and type 2 diabetes. BMC Infect Dis 2002; 2: 1
• 14 Corsello S, Spinillo A, Osnengo G. et al. An epidemiological survey of vulvovaginal candidiasis in Italy. Eur J Obstet Gynecol Reprod Biol 2003; 110: 66-72
• 15 Paultisch A, Weger W, Ginter-Hanselmayer G. et al. A 5-year (2000–2004) epidemiological survey of Candida and non-Candida yeast sepcies causing vulvovaginal candidiasis in Graz. Austria Mycoses 2006; 49: 471-475
• 16 Odds F. Candida and Candidosis. 2nd ed.. ed. London: Bailliere Tindall (WB Saunders); 1988
• 17 Spinillo A, Capuzzo E, Egbe TO. et al. Torulopsis glabrata Vaginitis. Obstet Gynecol 1995; 85: 993-998
• 18 Nyirjesy P, Alexander AB, Weitz MV. Vaginal Candida parapsilsosis: Pathogen or bystander?. Infect Dis Obstet Gynecol 2005; 13: 37-41
• 19 Singh S, Sobel JD, Bhargava P. et al. Vaginitis due to candida krusei: Epidemiology, Clinical aspects, and therapy. Clin Infect Dis 2002; 35: 1066-1070
• 20 Mendling W. Vaginose, Vaginitis, Zervizitis und Salpingitis. 2. Aufl.. Heidelberg: Springer; 2006
• 21 Sobel JD, Vazquez J, Lynch M. et al. Vaginitis due to Saccharomyces cerevisiae: epidemiology, clinical aspects, and therapy. Clin Infect Dis 1993; 16: 93-99
• 22 Fidel PL. Immunity in vaginal candidiasis. Curr Opin Infect Dis 2005; 18: 107-111
• 23 Yano J, Peters BM, Noverr MC. et al. Novel Mechanism behind the Immunopathogenesis of Vulvovaginal Candidiasis: “Neutrophil Anergy”. Infect Immun 2018; 86: e00684-17
• 24 Farrell SM, Hawkins DF, Ryder TA. Scanning electron microscope study of Candida albicans invasion of cultured human cervical epithelial cells. Sabouraudia 1983; 21: 251-254
• 25 Trumbore DJ, Sobel JD. Recurrent vulvovaginal candidiasis: vaginal epithelial cell susceptibility to Candida albicans adherence. Obstet Gynecol 1986; 67: 810-812
• 26 Sobel JD, Myers PG, Kaye D. et al. Adherence of Candida albicans to human vaginal and buccal epithelial cells. J Infect Dis 1981; 143: 76-82
• 27 De Bernardis F, Agatensi L, Ross IK. et al. Evidence for a role for secreted aspartate proteinase of Candida albicans in vulvovaginal candidiasis. J Infect Dis 1990; 161: 1276-1283
• 28 Naglik J, Albrecht A, Bader O. et al. Candida albicans proteinases and host/pathogen interactions. Cell Microbiol 2004; 6: 915-926
• 29 Ruchel R, Tegeler R, Trost M. A comparison of secretory proteinases from different strains of Candida albicans. Sabouraudia 1982; 20: 233-244
• 30 Ghannoum MA. Potential role of phospholipases in virulence and fungal pathogenesis. Clin Microbiol Rev 2000; 13: 122-143
• 31 Cassone A, De Bernardis F, Mondello F. et al. Evidence for a correlation between proteinase secretion and vulvovaginal candidosis. J Infect Dis 1987; 156: 777-783
• 32 Meinhof W. [Hydrochloric acid tolerance of Candida albicans]. Mykosen 1974; 17: 339-347
• 33 Lattif AA, Prasad R, Banerjee U. et al. The glyoxylate cycle enzyme activities in the pathogenic isolates of Candida albicans obtained from HIV/AIDS, diabetic and burn patients. Mycoses 2006; 49: 85-90
• 34 Cunha C, Carvalho A, Esposito A. et al. DAMP signaling in fungal infections and diseases. Front Immunol 2012; 3: 286
• 35 Zhao X, Malloy PJ, Ardies CM. et al. Oestrogen-binding protein in Candida albicans: antibody development and cellular localization by electron immunocytochemistry. Microbiology 1995; 141 (Pt 10): 2685-2692
• 36 Dennerstein G, Ellis DH. Oestrogen, glcogen and vaginal candidiasis. Obstet Gynecol 2001; 41: 326
• 37 Weissenbacher T, Witkin SS, Ledger WJ. et al. Relationship between clinical diagnosis of recurrent vulvovaginal candidiasis and detection of Candida species by culture and polymerase chain reaction. Arch Gynecol Obstet 2009; 279: 125-129
• 38 Beigi RH, Meyn LA, Moore DM. et al. Vaginal yeast colonization in nonpregnant women: a longitudinal study. Obstet Gynecol 2004; 104: 926-930
• 39 Mendling W, Gutschmidt J, Gantenberg R. Vergleich der Stammspezifität von Hefepilzen verschiedener Lokalisation bei Frauen mit Vaginalcandidosen. Mycoses 1998; 41: 23-25
• 40 Ruhnke M, Grosch-Worner I, Lischewski A. et al. Genotypic relatedness of yeast isolates from women infected with human immunodeficiency virus and their children. Mycoses 1999; 42: 385-394
• 41 Bohannon NJ. Treatment of vulvovaginal candidiasis in patients with diabetes. Diabetes Care 1998; 21: 451-456
• 42 Yano J, Sobel JD, Nyirjesy P. et al. Current patient perspectives of vulvovaginal candidiasis: incidence, symptoms, management and post-treatment outcomes. BMC Womens Health 2019; 19: 48
• 43 Donders GGG, Bellen G, Ruban K. et al. Short- and long-term influence of the levonorgestrel-releasing intrauterine system (Mirena(R)) on vaginal microbiota and Candida. J Med Microbiol 2018; 67: 308-313
• 44 Denning DW, Kneale M, Sobel JD. et al. Global burden of recurrent vulvovaginal candidiasis: a systematic review. Lancet Infect Dis 2018; 18: e339-e347
• 45 Unnikrishnan AG, Kalra S, Purandare V. et al. Genital infections with sodium glucose cotransporter-2 inhibitors: Occurrence and management in patients with type 2 diabetes mellitus. Indian J Endocrinol Metab 2018; 22: 837-842
• 46 Nyirjesy P, Sobel JD, Fung A. et al. Genital mycotic infections with canagliflozin, a sodium glucose co-transporter 2 inhibitor, in patients with type 2 diabetes mellitus: a pooled analysis of clinical studies. Curr Med Res Opin 2014; 30: 1109-1119
• 47 Willems HME, Ahmed SS, Liu J. et al. Vulvovaginal Candidiasis: A Current Understanding and Burning Questions. J Fungi (Basel) 2020; 6: 27
• 48 Eckert LO, Hawes SE, Stevens CE. et al. Vulvovaginal Candidiasis: clinical manifestations, risk factors, management algorithm. Obstet Gynecol 1998; 92: 757-765
• 49 Pirotta MV, Gunn JM, Chondros P. “Not thrush again!” Womenʼs experience of post-antibiotic vulvovaginits. Med J Aust 2003; 179: 43-46
• 50 Pirotta MV, Garland SM. Genital Candida species detected in samples from women in Melbourne, Australia, before and after treatment with antibiotics. J Clin Microbiol 2006; 44: 3213-3217
• 51 Xu J, Schwartz K, Bartoces M. et al. Effect of antibiotics on vulvovaginal candidiasis: a MetroNet study. J Am Board Fam Med 2008; 21: 261-268
• 52 Shukla A, Sobel JD. Vulvovaginitis Caused by Candida Species Following Antibiotic Exposure. Curr Infect Dis Rep 2019; 21: 44
• 53 Auger P, Joly J. Microbial flora associated with Candida albicans vulvovaginitis. Obstet Gynecol 1980; 55: 397-401
• 54 Aagaard K, Riehle K, Ma J. et al. A metagenomic approach to characterization of the vaginal microbiome signature in pregnancy. PLoS One 2012; 7: e36466
• 55 Hummelen R, Macklaim JM, Bisanz JE. et al. Vaginal microbiome and epithelial gene array in post-menopausal women with moderate to severe dryness. PLoS One 2011; 6: e26602
• 56 De Seta F, Parazzini F, De Leo R. et al. Lactobacillus plantarum P17630 for preventing Candida vaginitis recurrence: a retrospective comparative study. Eur J Obstet Gynecol Reprod Biol 2014; 182: 136-139
• 57 Mailander-Sanchez D, Wagener J, Schaller M. Potential role of probiotic bacteria in the treatment and prevention of localised candidosis. Mycoses 2012; 55: 17-26
• 58 Martinez RC, Seney SL, Summers KL. et al. Effect of Lactobacillus rhamnosus GR-1 and Lactobacillus reuteri RC-14 on the ability of Candida albicans to infect cells and induce inflammation. Microbiol Immunol 2009; 53: 487-495
• 59 Pendharkar S, Brandsborg E, Hammarstrom L. et al. Vaginal colonisation by probiotic lactobacilli and clinical outcome in women conventionally treated for bacterial vaginosis and yeast infection. BMC Infect Dis 2015; 15: 255
• 60 Ismail AM, Abbas AM, Shams AH. et al. The effect of use of vaginal Lactobacillus rhamnosus for prevention of recurrence of vulvovaginal candidiasis: a randomized controlled trial. Thai J Obstet Gynaecol 2017; 25: 62-68
• 61 Santos CMA, Pires MCV, Leao TL. et al. Selection of Lactobacillus strains as potential probiotics for vaginitis treatment. Microbiology 2016; 162: 1195-1207
• 62 Dennerstein GJ, Ellis DH. Oestrogen, glycogen and vaginal candidiasis. Aust N Z J Obstet Gynaecol 2001; 41: 326-328
• 63 Naglik JR, Gaffen SL, Hube B. Candidalysin: discovery and function in Candida albicans infections. Curr Opin Microbiol 2019; 52: 100-109
• 64 Fischer G, Bradford J. Vulvovaginal candidiasis in postmenopausal women: the role of hormone replacement therapy. J Low Genit Tract Dis 2011; 15: 263-267
• 65 van de Wijgert JHHM, Verwijs MC, Turner AN. et al. Hormonal contraception decreases bacterial vaginosis but oral contraception may increase candidiasis: implications for HIV transmission. AIDS 2013; 27: 2141-2153
• 66 Spacek J, Kestranek J, Jilek P. et al. Comparison of two long-term gestagen regimens in the management of recurrent vulvovaginal candidiasis: A pilot study. Mycoses 2017; 60: 260-265
• 67 Babula O, Lazdāne G, Kroica J. et al. Frequency of interleukin-4 (IL-4) − 589 gene polymorphism and vaginal concentrations of IL-4, nitric oxide, and mannose-binding lectin in women with recurrent vulvovaginal candidiasis. Clin Infect Dis 2005; 40: 1258-1262
• 68 Donders GG, Babula O, Bellen G. et al. Mannose-binding lectin gene polymorphism and resistance to therapy in women with recurrent vulvovaginal candidiasis. BJOG 2008; 115: 1225-1231
• 69 Chaim W, Foxman B, Sobel JD. Association of recurrent vaginal candidiasis and secretory ABO and Lewis phenotype. J Infect Dis 1997; 176: 828-830
• 70 Nyman GSA, Tang M, Inerot A. et al. Contact allergy to beeswax and propolis among patients with cheilitis or facial dermatitis. Contact Dermatitis 2019; 81: 110-116
• 71 Cassone A, Casadevall A. Recent progress in vaccines against fungal diseases. Curr Opin Microbiol 2012; 15: 427-433
• 72 Holland SM, Vinh DC. Yeast infections – Human genetics on the rise. N Engl J Med 2009; 361: 1798-1801
• 73 de Jong MA, Vriend LE, Theelen B. et al. C-type lectin Langerin is a beta-glucan receptor on human Langerhans cells that recognizes opportunistic and pathogenic fungi. Mol Immunol 2010; 47: 1216-1225
• 74 Romani L. Immunity to fungal infections. Nat Rev Immunol 2004; 4: 1-23
• 75 Vecchiarelli A, Pericolini E, Gabrielli E. et al. New approaches in the development of a vaccine for mucosal candidiasis: progress and challenges. Front Microbiol 2012; 3: 294
• 76 Neves NA, Carvalho LP, De Oliveira MA. et al. Association between atopy and recurrent vaginal candidiasis. Clin Exp Immunol 2005; 142: 167-171
• 77 Reed BD, Zazove P, Pierson CL. et al. Candida transmission and sexual behaviors as risks for a repeat episode of Candida vulvovaginits. J Womens Health (Larchmt) 2003; 12: 979-989
• 78 Rylander E, Berglund AL, Krassny C. et al. Vulvovaginal candida in a young sexually active population: prevalence and association with oro-genital sex and frequent pain at intercourse. Sex Transm Infect 2004; 80: 54-57
• 79 Ehrstrom SM, Kornfeld D, Thuresson J. et al. Signs of chronic stress in women with recurrent candida vulvovaginitis. Am J Obstet Gynecol 2005; 193: 1376-1381
• 80 Meyer H, Goettlicher S, Mendling W. Stress as a cause of chronic recurrent vulvovaginal candidosis and the effectiveness of the conventional antimycotic therapy. Mycoses 2006; 49: 202-209
• 81 Cruickshank R. Acquired Immunity: Bacterial Infections. Mod Trends Immunol 1963; 1: 107-129
• 82 Donders GG, Prenen H, Verbeke G. et al. Impaired tolerance for glucose in women with recurrent vaginal candidiasis. Am J Obstet Gynecol 2002; 187: 989-993
• 83 Eckert LO, Hawes SE, Stevens CE. et al. Vulvovaginal candidiasis: clinical manifestations, risk factors, management algorithm. Obstet Gynecol 1998; 92: 757-765
• 84 Anderson MR, Klink K, Cohrssen A. Evaluation of vaginal complaints. JAMA 2004; 291: 1368-1379
• 85 Spacek J, Jilek P, Buchta V. The serum levels of calcium, magnesium, iron and zinc in patients with recurrent vulvovaginal candidosis during attack, remission and in healthy controls. Mycoses 2005; 48: 391-395
• 86 Fidel jr. PL, Vazquez JA, Sobel JD. Candida glabrata: Review of epidemiology, pathogenesis, and clincal disease with comparison to C. albicans. Clin Microbiol Rev 1999; 12: 80-96
• 87 Sobel JD. Vulvovaginitis due to Candida glabrata. An emerging problem. Mycoses 1998; 41: 18-22
• 88 Mendling W. [Torulopsis in gynecology]. Geburtshilfe Frauenheilkd 1984; 44: 583-586
• 89 Savini V, Catavitello C, Manna A. et al. Two cases of vaginitis caused by itraconazole-resistant Saccharomyces cerevisiae and a review of recently published studies. Mycopathologia 2008; 166: 47-50
• 90 Aballéa S, Guelfucci F, Wagner J. et al. Subjective health status and health-related qualitiy of life among women with Recurrent Vulvovaginal Candidosis (RVVC) in Europe and the USA. Health Qual Life Outcomes 2013; 11: 169
• 91 Mylonas I, Bergauer F. Diagnosis of vaginal discharge by wet mount microscopy: a simple and underrated method. Obstet Gynecol Surv 2011; 66: 359-368
• 92 Müller J, Nold B, Kubitza D. et al. Quantitative Untersuchungen über die Döderlein-Flora gesunder sowie mykosekranker Probandinnen unter lokaler Isoconazol-Nitrat-Therapie. In: Seeliger HPR. Hrsg. Gyno – Travogen, Monographie Excerpta Medica. Amsterdam: Oxford Princeton; 1981: 81-93
• 93 Nyirjesy P, Seeney SM, Grody MH. et al. Chronic fungal vaginitis: the value of cultures. Am J Obstet Gynecol 1995; 173 (3 Pt 1): 820-823
• 94 Hoffstetter SE, Barr S, LeFevre C. et al. Self-reported yeast symptoms compared with clinical wet mount analysis and vaginal yeast culture in a specialty clinic setting. J Reprod Med 2008; 53: 402-406
• 95 Mulhem E, Boyanton BL, Robinson-Dunn B. et al. Performance of the Affirm VP-III using residual vaginal discharge collected from the speculum to characterize vaginitis in symptomatic women. J Low Genit Tract Dis 2014; 18: 344-346
• 96 Bradford LL, Chibucos MC, Ma B. et al. Vaginal Candida spp. genomes from women with vulvovaginal candidiasis. Pathog Dis 2017; 75: ftx061
• 97 Wilson C. Recurrent vulvovaginitis candidiasis; an overview of traditional and alternative therapies. Adv Nurse Pract 2005; 13: 24-29 quiz 30
• 98 Plempel M. [Pharmacokinetics of imidazole-antimycotics]. Mykosen 1980; 23: 16-27
• 99 Scheklakow ND, Delektorski WW, Golodova OA. [Ultrastructural changes in Candida albicans caused by polyene antibiotics (authorʼs transl)]. Mykosen 1981; 24: 140-152
• 100 Niewerth M, Kunze D, Seibold M. et al. Ciclopirox olamine treatment affects the expression pattern of Candida albicans genes encoding virulence factors, iron metabolism proteins, and drug resistance factors. Antimicrob Agents Chemother 2003; 47: 1805-1817
• 101 Ritter W. Pharmacokinetics of Azole Compounds. In: Berg D, Plempel M. eds. Sterol Biosynthesis Inhibitors. Chichester: Ellis Horwood; 1988: 397-429
• 102 Fan S, Liu X, Liang Y. Miconazole nitrate vaginal suppository 1,200 mg versus oral fluconazole 150 mg in treating severe vulvovaginal candidiasis. Gynecol Obstet Invest 2015; 80: 113-118
• 103 Mendling W. Azoles in the Therapy of vaginal Candidosis. In: Berg D, Plempel M. eds. Sterol Biosynthesis Inhibitors. Chichester: Ellis Horwood; 1988: 480-506
• 104 Wajnberg M, Wajnberg A. [A comparative double blind trial with vaginal creams of cyclopyroxolamine and miconazole in vulvovaginal candidosis (authorʼs transl)]. Mykosen 1981; 24: 721-730
• 105 das Neves J, Pinto E, Teixeira B. et al. Local treatment of vulvovaginal candidosis: general and practical considerations. Drugs 2008; 68: 1787-1802
• 106 Moran GP, Sanglard D, Donnelly SM. et al. Identification and expression of multidrug transporters responsible for fluconazole resistance in Candida dubliniensis. Antimicrob Agents Chemother 1998; 42: 1819-1830
• 107 Sobel JD. Management of recurrent vulvovaginal candidiasis with intermittent ketokonazole prophylaxis. Obstet Gynecol 1985; 65: 435-440
• 108 Davidson F, Mould RF. Recurrent genital candidosis in women and the effect of intermittent prophylactic treatment. Br J Vener Dis 1978; 54: 176-183
• 109 Roth AC, Milsom I, Forssman L. et al. Intermittent prophylactic treatment of recurrent vaginal candidiasis by postmenstrual application of a 500 mg clotrimazole vaginal tablet. Genitourin Med 1990; 66: 357-360
• 110 Sobel JD, Wiesenfeld H, Martens M. Maintenance fluconazole therapy for recurrent vulvovaginal candidiasis. N Engl J Med 2004; 35: 875-883
• 111 Sobel JD. Recurrent vulvovaginal candidiasis. Am J Obstet Gynecol 2016; 214: 15-21
• 112 Donders G, Bellen G, Byttebier G. et al. Individualized decreasing-dose maintenance fluconazole regimen for recurrent vulvovaginal candidiasis (ReCiDiF trial). Am J Obstet Gynecol 2008; 199: 613.e1-613.e9
• 113 Donders GGG, Grinceviciene S, Bellen G. et al. Is non-response to fluconazole maintenance therapy for recurrent Candida vaginitis related to sensitization to atopic reactions?. Am J Reprod Immunol 2018; 79: e12811
• 114 Ho J, Wickramasinghe DN, Nikou S-A. et al. Candidalysin Is a Potent Trigger of Alarmin and Antimicrobial Peptide Release in Epithelial Cells. Cells 2020; 9: 699
• 115 Grinceviciene S, Ruban K, Bellen G. et al. Sexual behaviour and extra-genital colonisation in women treated for recurrent Candida vulvo-vaginitis. Mycoses 2018; 61: 857-860
• 116 Czeizel AE, Tóth M, Rockenbauer M. No teratogenic effect after clotrimazole therapy during pregnancy. Epidemiology 1999; 10: 437-440
• 117 Czeizel AE, Fladung B, Vargha P. Preterm birth reduction after clotrimazole treatment during pregnancy. Eur J Obstet Gynecol Reprod Biol 2004; 116: 157-163
• 118 Czeizel AE, Puhó EH, Kazy Z. The use of data set of the Hungarian case-control surveillance of congenital abnormalities for evaluation of birth outcomes beyond birth defects. Cent Eur J Public Health 2007; 15: 147-153
• 119 Hay P, Czeizel AE. Asymptomatic trichomonas and candida colonization and pregnancy outcome. Best Pract Res Clin Obstet Gynaecol 2007; 21: 403-409
• 120 Kiss H, Petricevic L, Husslein P. Prospective randomised controlled trial of an infection screening programme to reduce the rate of preterm delivery. BMJ 2004; DOI: 10.1136/bmj.3869.519653.EB.
• 121 Roberts CL, Rickard K, Kotsiou G. et al. Treatment of asymptomatic vaginal candidiasis in pregnancy to prevent preterm birth: an open-label pilot randomized controlled trial. BMC Pregnancy Childbirth 2011; 11: 18
• 122 Farr A, Kiss H, Holzer I. et al. Effect of asymptomatic vaginal colonization with Candida albicans on pregnancy outcome. Acta Obstet Gynecol Scand 2015; 94: 989-996
• 123 Blaschke-Hellmessen R. Subpartale Übertragung von Candida und ihre Konsequenzen. Mycoses 1998; 41: 31-36
• 124 Blaschke-Hellmessen R. [Epidemiological studies of the occurrence of yeasts in children and their mothers]. Mykosen 1968; 11: 611-616
• 125 Howley MM. Using meta-analyses to improve risk estimates of specific birth defects. BJOG 2019; 126: 1553
• 126 Molgaard-Nielsen D, Pasternak B, Hviid A. Use of oral fluconazole during pregnancy and the risk of birth defects. N Engl J Med 2013; 369: 830-839
• 127 Molgaard-Nielsen D, Svanstrom H, Melbye M. et al. Association Between Use of Oral Fluconazole During Pregnancy and Risk of Spontaneous Abortion and Stillbirth. JAMA 2016; 315: 58-67
• 128 Della Casa V, Noll H, Gonser S. et al. Antimicrobial activity of dequalinium chloride against leading germs of vaginal infections. Arzneimittel-Forschung 2002; 52: 699-705
• 129 Frey Tirri B. Antimicrobial topical agents used in the vagina. Curr Probl Dermatol 2011; 40: 36-47
• 130 Mendling W, Weissenbacher ER, Gerber S. et al. Use of locally delivered dequalinium chloride in the treatment of vaginal infections: a review. Arch Gynecol Obstet 2016; 293: 469-484
• 131 Walker PP, Reynolds MT, Ashbee HR. et al. Vaginal yeasts in the era of “over the counter” antifungals. Sex Transm Infect 2000; 76: 437-438
• 132 Ferris DG, Nyirjesy P, Sobel JD. et al. Over-the-counter antifungal drug misuse associated with patient-diagnosed vulvovaginal candidiasis. Obstet Gynecol 2002; 99: 419-425
• 133 Mardh PA, Novikova N, Stukalova E. Colonisation of extragenital sites by Candida in women with recurrent vulvovaginal candidosis. BJOG 2003; 110: 934-937
• 134 Felix TC, de Brito Röder DVD, Dos Santos Pedroso R. Alternative and complementary therapies for vulvovaginal candidiasis. Folia Microbiol (Praha) 2019; 64: 133-141
• 135 Russo R, Superti F, Karadja E. et al. Randomised clinical trial in women with Recurrent Vulvovaginal Candidiasis: Efficacy of probiotics and lactoferrin as maintenance treatment. Mycoses 2019; 62: 328-335
• 136 Chew SY, Cheah YK, Seow HF. et al. Probiotic Lactobacillus rhamnosus GR-1 and Lactobacillus reuteri RC-14 exhibit strong antifungal effects against vulvovaginal candidiasis-causing Candida glabrata isolates. J Appl Microbiol 2015; 118: 1180-1190
• 137 Kosgey JC, Jia L, Fang Y. et al. Probiotics as antifungal agents: Experimental confirmation and future prospects. J Microbiol Methods 2019; 162: 28-37
• 138 Capoci IR, Bonfim-Mendonça Pde S, Arita GS. et al. Propolis Is an Efficient Fungicide and Inhibitor of Biofilm Production by Vaginal Candida albicans. Evid Based Complement Alternat Med 2015; 2015: 287693
• 139 Ahangari F, Farshbaf-Khalili A, Javadzadeh Y. et al. Comparing the effectiveness of Salvia officinalis, clotrimazole and their combination on vulvovaginal candidiasis: A randomized, controlled clinical trial. J Obstet Gynaecol Res 2019; 45: 897-907
• 140 Huang Y, Merkatz RB, Hillier SL. et al. Effects of a One Year Reusable Contraceptive Vaginal Ring on Vaginal Microflora and the Risk of Vaginal Infection: An Open-Label Prospective Evaluation. PLoS One 2015; 10: e0134460